Provider Demographics
NPI:1275166746
Name:HOLDER, ELENI (RPH)
Entity Type:Individual
Prefix:
First Name:ELENI
Middle Name:
Last Name:HOLDER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3320 VETERANS DR
Mailing Address - Street 2:
Mailing Address - City:PEKIN
Mailing Address - State:IL
Mailing Address - Zip Code:61554-9317
Mailing Address - Country:US
Mailing Address - Phone:309-353-2995
Mailing Address - Fax:
Practice Address - Street 1:3320 VETERANS DR
Practice Address - Street 2:
Practice Address - City:PEKIN
Practice Address - State:IL
Practice Address - Zip Code:61554-9317
Practice Address - Country:US
Practice Address - Phone:309-353-2995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-12
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051-033690183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist